Septic Shock pp 116-128 | Cite as

The Role of Proteolytic Enzyme Systems with Particular Emphasis on the Plasma Kallikrein-Kinin System During Septicemia and Septic Shock

  • A. O. Aasen
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 4)

Abstract

Both in endotoxin shock in experimental animals and during septicemia in man pronounced proteolytic activity of plasma has been observed. Proteolytic involvement in this state due to activation of the coagulation and the fibrinolytic system was detected many years ago [1, 2]. Some early studies also suggested that the kallikrein-kinin system might be of significance for the pathophysiological changes seen [3, 4]. Clinical studies performed during the seventies provided more solid data which put particular emphasis on activation of the kallikreinkinin and complement systems for the development of shock and death during endotoxemia [5–7]. In a study on soldiers wounded in battle during the Vietnamese war, it was observed that blood samples obtained from those who died of gram-negative septicemia had very low contents of high molecular weight kininogen [7]. In the patients surviving gram-negative septicemia, the blood kininogen levels, after an initial lowering, rose towards normal values.

Keywords

Leukemia Amid Pancreatitis Serine Arginine 

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References

  1. 1.
    McKay DG, Wahle GH Jr (1955) Epidemic gastroenteritis due to Escherichia coli 0111B4. Arch. Pathol 60: 679–696Google Scholar
  2. 2.
    Rapaport SI, Tatter D, Coer-Barron N, Hjort PF (1964) Pseudomonas septicemia with intravascular clotting leading to the generalized Shwartzman reaction. N Engl J Med 271: 80–84PubMedCrossRefGoogle Scholar
  3. 3.
    Diniz CR, Carvalho IE (1963) A micromethod for determination of bradykinin under several condition. Ann N Y Acad Sci 104: 77–89PubMedCrossRefGoogle Scholar
  4. 4.
    Kobold EE, Lovell R, Katz W, Thal AP (1964) Chemical mediators released by endotoxin. Surg Gynecol Obstet 118: 807–813PubMedGoogle Scholar
  5. 5.
    Mason JW, Kleeberg U, Dolan P, Colman RW (1970) Plasma kallikrein and Hageman factor in gram-negative bacteremia. Ann Intern Med 73: 545–551PubMedGoogle Scholar
  6. 6.
    McCabe WR (1973) Serum complement levels in bacteremia due to gram-negative organisms. N Engl J Med 288: 21–23PubMedCrossRefGoogle Scholar
  7. 7.
    Hirsch EF, Nakajima T, Ishima G, Erdös EG, Herman CM (1974) Kinin system responses in sepsis after trauma in man. J Surg Res 17: 147–153PubMedCrossRefGoogle Scholar
  8. 8.
    Erdös EG (1976) The kinins. A status report. Biochem Pharmacol 25: 1563–1569PubMedCrossRefGoogle Scholar
  9. 9.
    McConn R, Wasserman F, Haberland G (1982) The kallikrein kinin system in the acutely ill: Changes in plasma kininogen in acutely ill patients and the efficacy of pulmonary clearance of bradykinin. In: McConn (ed) Role of chemical mediators in the pathophysiology of acute illness and injury. Raven Press, New York, pp 111–126Google Scholar
  10. 10.
    Schapira M, Scott CF, Colman RM (1982) Contribution of plasma protease inhibitors to the inactivation of kallikrein in plasma. J Clin Invest 69: 462–467PubMedCrossRefGoogle Scholar
  11. 11.
    Cochrane GG, Griffin JH (1982) The biochemistry and pathophysiology of the contact system of plasma. In: Kunkel HG, Dixon FJ (eds) Adv in Immunol. Vol 33. Academic press, New York, pp 241–306Google Scholar
  12. 12.
    Haverkate F, Brakman P (1975) Fibrin plate assay. In: Davidson JF, Samama MM, Des-Noyers PD (eds) Progress in chemical fibrinolysis and thrombolysis, Vol 1. Raven Press, New York, pp 151–159Google Scholar
  13. 13.
    Lachmann PJ, Hobart MJ, Aston WP (1973) Complement technology. In: Weir DM (ed) Handbook of Experimental Immunology, 2nd ed. Blackwell Scientific Publications, LondonGoogle Scholar
  14. 14.
    Schachter M (1969) Kallikreins and kinins. Physiol Rev 49: 509–547PubMedGoogle Scholar
  15. 15.
    Surovikina MS (1975) Components of the plasma kinin system in rabbits with acute inflammation. Bull Exp Biol Med 80: 41–43CrossRefGoogle Scholar
  16. 16.
    Svendsen L, Blombäck M, Olsson PI (1972) Synthetic chromogenic substrates for determination of trypsin, thrombin and thrombin-like enzymes. Thromb Res 1: 267–278CrossRefGoogle Scholar
  17. 17.
    Abilgaard U, Lie M, Qdegârd OR (1976) A simple amidolytic method for the determination of functionally active antithrombin III. Scand J Clin Lab Invest 36: 109–112CrossRefGoogle Scholar
  18. 18.
    Amundsen E, Svendsen L, Vennerod AM, Laake K (1977) Determination of plasma kallikrein with a new chromogenic tripeptide derivative. Pisano JJ, Austen KF (eds) Chemistry and biology of the kallikrein-kinin system in health and disease. Fogarty International Center Prodeedings, No. 27, Washington, D.C. U.S. Government Printing Office, pp 215–220Google Scholar
  19. 19.
    Aasen AO, Kierulf P, Stremme J (1982) Methodological considerations on chromogenic peptide substrate assays and application on automated analyzer. Acta Chir Scand Suppl 509: 17–22PubMedGoogle Scholar
  20. 20.
    Friberger P (1982) Chromogenic peptide substrates. Their use for the assay of factors in the fibrinolytic and the kallikrein-kinin system. Scand J Clin Lab Invest 42 (suppl): 162Google Scholar
  21. 21.
    Thal AP, Brown EB, Hermreck AS, Bell HH (1971) Shock. A physiological basis for treatment. Year book medical publishers, INC. ChicagoGoogle Scholar
  22. 22.
    Shatney CH, Lillehei RC (1978) Septic shock associated with operation for colorectal disease. Dis Colon Rectum 27: 480–486CrossRefGoogle Scholar
  23. 23.
    Aasen AO, Smith-Erichsen N, Gallimore MJ, Amundsen E (1980) Studies on the components of the plasma kallikrein-kinin systems in plasma samples from normal individuals and patients with septic shock. Advances in Shock Research. Liss. Inc, New York, vol IV, pp 1–10Google Scholar
  24. 24.
    Fritz H (1980) Proteinase inhibitors in severe inflammatory processes (septic shock and experimental endotoxemia): Biochemical, pathophysiological and therapeutic aspects. In: Protein degradation in health and disease. Ciba Foundation Symp. 75 ( New Series). Excerpta Medica, Amsterdam, pp 351–379Google Scholar
  25. 25.
    Smith Erichsen N, Aasen AO, Amundsen E (1982) Treatment of sepsis in the surgical patient evaluted by means of chromogenic peptide substrate assays. Acta Chir Scand 509: 33–38CrossRefGoogle Scholar
  26. 26.
    Kalter ES, Timmermanns A, Bouma BN (1982) The kinin generating system during sepsis and bacterial shock. Agents Actions 9: 638–644Google Scholar
  27. 27.
    Aasen AO, Smith-Erichsen N, Amundsen E (1983) Plasma kallikrein-kinin system in septicemia. Arch Surg 118: 343–346PubMedGoogle Scholar
  28. 28.
    Kalter ES, Daha MR, ten Lab JN, Verhoef J, Bouma BN (1985) Activation and inhibition of Hageman factor-dependent pathways and the complement system in uncomplicated bacteremia or bacterial shock. J Infect Dis 151: 1019–1027PubMedCrossRefGoogle Scholar
  29. 29.
    Ohlsson K, Olsson I (1974) Neutral proteases of human granulocytes III. Interactions between human granulocyte elestase and plasma protease inhibitors. Scand J Clin Lab Invest 34: 349–355PubMedCrossRefGoogle Scholar
  30. 30.
    Egbring R, Smidt W, Fuchs G, Habemann K (1977) Demonstration of granulocyte pro-teases in plasma of patients with acute leukemia and septicemia with coagulation defects. Blood 49: 219–231PubMedGoogle Scholar
  31. 31.
    Fritz H, Jochum M, Duswald K-H, Dittmer H, Kortmann H, Neumann S, Lang H (1984) Granulocyte proteinases as mediators of unspecific proteolysis in inflammation. A review. In: Goldberg DM, Werner M (eds) Selected Topics in Clinical Enzymology, Vol 2. de Gruyter, Berlin, pp 305–328Google Scholar
  32. 32.
    Duswald K-H, Jochum M, Schramm W, Fritz H (1985) Release of granulocytic elastase: An indicator of pathobiochemical alterations in septicemia after abdominal surgery. Surgery 98: 892–899PubMedGoogle Scholar
  33. 33.
    Sprung CL, Schultz DR, Marcial E, Charlis PV, Gelbard MA, Arnold PI, Long WM (1986) Complement activation in septic shock patients. Crit Care Med 14: 525–528PubMedCrossRefGoogle Scholar
  34. 34.
    Gallimore MJ, Aasen AO, Smith-Erichsen N, Lassbraaten M, Lyngaas K, Amundsen E (1980) Plasminogen concentrations and functional activities and concentrations of plasmin inhibitors in plasma samples from normal subjects and patients with septic shock. Thromb Res 18: 601–608PubMedCrossRefGoogle Scholar
  35. 35.
    ten Cate JW (1982) Antithrombin-III: Clinical significance. Acta Chir Scand 509: 101–105Google Scholar
  36. 36.
    Scipper HG, Roos J, van der Meulen F, ten Cate JW (1981) Antithrombin III deficiency in surgical intensive care patients. Thromb Res 21: 73–80CrossRefGoogle Scholar
  37. 37.
    Buller HR, Bolwerk C, ten Cate J, Roos J, Kahlé LH, ten Cate JW (1982) Postoperative hemostatic profile in relation to gram-negative septicemia. Critical Care Med 10: 311–315CrossRefGoogle Scholar
  38. 38.
    Witte J, Jochum M, Scherer R, Schramm W, Hochstrasser K, Fritz H (1982) Distribution of selected plasma proteins in hyperdynamic septic shock. Intensive Care Med 8: 215–222PubMedCrossRefGoogle Scholar
  39. 39.
    Lämmle B, Tran TH, Ritz R, Duckett F (1984) Plasma prekallikrein, F XII, Antithrombin III, Cl-inhibitor and α2-macroglobulin in critically ill patients with suspected disseminated intravascular coagulation ( DIC ). Am J Clin Pathol 82: 396–404PubMedGoogle Scholar
  40. 40.
    Aasen AO (1983) Evaluation of septic and severe traumatized patients by means of a new parameter. The proenzyme functional inhibition index. The Second Tore Nilson Symposium, Linköpin, Sweden, Sept 7–10Google Scholar
  41. 41.
    Aasen AO (1985) The proenzyme functional inhibition index. A new parameter for evaluation of the severely injured and septic patient. Acta Chir Scand Suppl 522: 211–233PubMedGoogle Scholar
  42. 42.
    Smith-Erichsen N, Aasen AO (1984) Evaluation of severity and prognosis in early stages of septicemia by means of chromogenic peptide substrate assays. Eur Surg Res 2: 140–146CrossRefGoogle Scholar
  43. 43.
    Balldin G, Ohlsson K (1979) Demonstration of pancreatic protease-antiprotease complexes in the peritoneal fluid of patients with acute pancreatitis. Surgery 85: 451–456PubMedGoogle Scholar
  44. 44.
    Lasson A (1984) Acute pancreatitis in man: A clinical and biochemical study of pathophysiology and treatment. Thesis, University of Lund. Scand J Gastro Enterol (Suppl) 99Google Scholar
  45. 45.
    Schipper HG, Kahle LH, Jenkins CSP, ten Cate JW (1978) Antithrombin III transfusion in disseminated intravascular coagulation. Lancet 2: 854–856CrossRefGoogle Scholar
  46. 46.
    van der Starre P, Sinclair D, Damen J (1980) Inhibition of the hypotensive effect of plasma protein solutions by C1-esterase inhibitor. J Thorac Cardiovasc Surg 79: 738–741PubMedGoogle Scholar
  47. 47.
    Kalter ES, van Dijk WC, Timmermanns A, Verhoef J, Bouma BN (1983) Activation of purified human plasma prekallikrein triggered by cell wall fractions of Escherichia coli and Straphylococcus aureus. J Infect Dis 148: 682–691PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1987

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  • A. O. Aasen

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